A patient, female, 67 years old, with adenocarcinoma of Vater's papilla, in addition to arteriographic evidence of occlusion of the celiac axis underwent pancreaticoduodenectomy. In oder to assure sufficient blood flow to upper abdominal viscera, dorsal pancreatic artery was preserved. She has experienced no severe postoperative complications and lives a healthy life now, over 5 years after operation.
Occlusion of the celiac axic itself causes no clinical problems, because upper abdominal viscera can be maintained by collateral blood flow through the pancreatic arcades from the superior mesenteric artery. But in case of pancreaticoduodenectomy sacrificing the pancreatic arcades may cause ischemia of upper abdominal viscera and attendant severe postoperative complications.
The potential contribution of ischemia of upper abdominal viscera to postoperative complications remains unclear now. But the incidence of severe stenosis of the celiac axis due to arteriosclerotic diseases is high, so that we should consider the ischemic state of upper abdominal viscera after operation such as pancreaticoduodenectomy and total pancreatectomy to be a cause of postoperative complications.
We also emphasize the need for preoperative celiac and superior mesenteric arteriography, especially that of on lateral view.